In
my last blog I blog, I began the discussion of chronic pain. My friend and colleague, Peter Blum, of
Woodstock, New York (who actually does everything, including hypnosis, and is a
Buddhist, Jewish, Native American priest of sorts who married Barbara and me)
had important things to say.

Peter
said, "This is a topic that has been particularly significant in my life, and I
would like to weigh in on this discussion. As a hypnotherapist, I have
addressed the issue of pain management with numerous clients over the years. As
a practicing Buddhist, I have read and studied and meditated for many years on
the "Four Noble Truths" - the essence of the Buddha's teaching -
which deals with the nature of suffering and attachment. And perhaps most
importantly, as a recovering drug addict, I have had direct experience with the
cunning, baffling, and seductive nature of what is currently often viewed as
the "disease" of addiction.

"In
your article, I loved what you said about the "seeking system", and
that "seeking has been found in studies to be more rewarding than
finding". That would be validated by many addicts, who speak of the
"high" of the hunt... the actual physical/emotional thrill of
figuring out ways to get more of whatever it was they were addicted to. I was a
bit surprised at the revelation, in your article, that in patients receiving
prolonged opioid therapy, there is an increase in production of one of the
body's endogenous opiates.

"Years
ago an acupuncturist (who was explaining how acupuncture was beneficial to
people who were in the process of detoxing from opiate addiction) used the
metaphor of the body having little "factories" which produced the
endorphines and enkaphalons, the feel-good neurotransmitters, which also regulate
pain control. When a person starts "importing" external opiates, such
as morphine, heroin, codeine, etc., on a regular basis, these little factories
shut down. So a person's natural ability to manage pain, and regulate mood, is
impaired and becomes dependent on continuing to receive these
"imports".

"It
was heartening to read of others who responded to your posting on this thread
speaking of utilizing mindfulness meditation as a tool in helping clients
understand the working of mind/body, and find other ways of coping with or
alleviating pain as an alternative to synthetic opiates. A recent issue of
"The Buddhist Review Tricycle" (Fall 2012) contained an insightful
article by Andrew Olendzki, entitled "Pinch Yourself - A Physical
Sensation Becomes An Experience To Be Explored". To quote briefly, in the
opening paragraph, Olendzki, a Ph.D., and senior scholar at the Barre Center
for Buddhist Studies, says "Pinch yourself. Go ahead and give yourself a
good hard pinch on the arm or the back of the hand. Now, according to Buddhist
psychology, you should be able to distinguish at least three different
components to the experience: the touch, the pain of the touch, and the
aversion to the pain of the touch. Our mind if very good at merging these all
together, but there are actually three different processes - synthesized by
three different brain systems - that are then synchronized with one another and
interpreted as a unified experience."

"Our
culture continually bombards us with media advertisements encouraging us to
immediately turn to the pharmacy to deal with the slightest pain. So before we
even sit with the touch, and the pain of the touch, we are proceeding instantly
to aversion to the pain of the touch. What if, instead, we were to center
ourselves and allow ourselves to sit with the pain. My experience, in hearing
the stories of many who use opiates, is that the "cover story" of
needing them to deal with physical pain, is frequently masking the deeper,
underlying story - of inability or unwillingness to deal with metaphysical
pain. Some of the therapeutic guidance we can give, is to encourage a person to
actually feel their pain - emotional, psychic, etc. To be willing to take a
look at the pain of their lives, and look at the situational reinforcements of
isolation and obsessive/compulsive behavior that, unless addressed and
ameliorated, will bring a person cycling back over and over again to the same
lonely and desperate places.

"It
was particularly heartening to read your last paragraph: "For all these
reasons, I believe we need to work together to create communities of pain
sufferers, to change their brains through social interaction (the social brain
hypnothesis) and to help each other to live better lives with or without
pain." This reinforces the hochoka project - of having community healing
circles. Many have found the rooms of Narcotics Anonymous to also fulfill that
function.

"But
whatever it is, it is a pervasive and rapidly growing problem. Many are
probably aware that prescription pain-killers are the drug of choice these days
recreationally among many high school and college age folks and are overtaking
heroin and cocaine as a cause of death by overdose; hospitalization for
complications, and treatment in detox and rehab facilities. Not to be overlooked
in this discussion is the mega-bucks of the pharmaceutical industry, and their
continued investment in pushing more pills. Thank goodness we have some
independent thinkers amongst our prescribing physicians who are willing to
explore other, healthier and more wholistic ways of helping clients deal with
pain."

In
our pain group, we are attempting to create community with people who have been
trained to avoid community. Our American culture trains people who are in pain
to isolate which only serves to increase their pain. So often, I hear people in pain say, "I hate
other people." We have to make them come
to the group at first in order to get their narcotics. They must come twice per month. Some eventually come more often. Some eventually begin to find that they enjoy
coming to group and come more often.
Slowly the stories we tell in group begin to diffuse into the
people. Some begin to feel that they
could have an influence by what they do on how much pain they feel.

No
correlation exists between the perceived severity of chronic pain and tissue
pathology.1 Chronic pain is diffuse and often spreads well beyond
the original area of injury. The
measures that are successful in treating acute pain rarely work for chronic
pain. This is because chronic pain is
manufactured in our brains as a modifying response to acute pain. Chronic pain is very much a phenomenon of our
brains and must be addressed as such.
It's something we invent after an acute pain. This is why we need each other to manage our
chronic pain.

Eighty
million Americans suffer with chronic pain and nearly one-third obtains little
or no relief from conventional approaches to pain.2 Therefore, new
approaches are needed besides the conventional model of writing
prescriptions. We need to combine
medicine with physical therapy, family therapy, cognitive/behavioral therapy,
biofeedback, support groups, and more. In addition to caring for the chronic
pain patient, the entire family is affected and needs to be involved in the
recovery process. Care needs to involve all the stakeholders in the chronic
pain patient's life.

Treatment
with opioids alone is not enough for chronic pain.3 For
some people, opioids may reduce chronic pain to a more tolerablelevel.
However, they should not be prescribed with the expectation that they willcompletely alleviate chronic pain, treat depression or a sleep disorder,
or completelyrelieve suffering.
For other people, opioids are ineffective. The deeper issue is, as Peter Blum puts it,
how can we allow ourselves to feel what we don't want to feel? Our culture is formed from stories that teach
us to avoid pain. We are full of magic
potion stories in which a substance takes that pain away. Unfortunately, the stories don't seem to
fully work. They are incomplete. The pain doesn't leave. The magic potions are not fully
effective. What are we to do in those
cases?

Specific
regional gray matter decreases correlate with duration of chronic pain, its
intensity, and the interaction between duration and intensity4-6,
suggesting that being in chronic pain changes the structure of the brain. Distinct chronic pain conditions have
differential impacts on brain anatomy. These brain changes are reversible with
pain relief .7-9 Apparently, some of the brain changes are a direct
consequence of the presence of the pain, and most likely the underlying mechanism
is based on synaptic plasticity that tracks the impact of the pain on the
brain. Structural brain changes can be observed at early time points from
initial injury as well as after long periods from injury, best illustrated in 2
animal studies.10,11

People
with chronic pain rarely just feel pain.
They have a myriad of other symptoms, including fatigue, poor sleep,
depression, anxiety, migraine, and so many more.1. Persistent stress alters neuroendocrine
rhythms. Chronic pain quickly becomes a
comprehensive mind-body-community-spirit phenomenon. It must be addressed from all those
levels.

"We
found that of the people who have tears in their discs [between the vertebrae
in the spine], some manage well with it and some manage poorly with it,"
said Dr. Eugene Carragee, associate professor of functional restoration at the
Stanford University Medical Center in California. Carragee and his team compared the results of
magnetic resonance images and vertebral disc tear tests among 96 patients who
had known risk factors for disc degeneration. Such tears have traditionally been
thought to directly cause lower back pain, with ruptures in the discs that
cushion contact between the vertebra bones resulting in painful pressure being
placed on sensitive nerves.

The
researchers were surprised to find that those patients with disc problems were
only slightly more likely to have back pain then those without any disc
degeneration. They also noted that 25% of those who did have disc problems had
no lower back pain at all. Carragee and his colleagues concluded that torn
discs are not always painful, and not all lower back pain is a result of a torn
disc.

Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)